Day 1 : June 19, 2017

Keynote Forum

Biography:

Dr. Lee Akst is head of the Johns Hopkins Voice Center and is Director of the Division of Laryngology at the Johns Hopkins University Department of Otolaryngology-Head and Neck Surgery. The focus of his clinical practice is on management of voice disorders, with focus on office-based treatments and operative management of epithelial diseases such as vocal cord leukoplakia, papilloma, and early glottis cancer. He has lectured extensively on phonosurgical techniques, treatment of laryngeal leukoplakia, laryngopharyngeal reflux, and globus pharyngeus. He has been working with engineers at Johns Hopkins on novel robotic platforms to bringing robotic surgery into the endolarynx to aid microlaryngeal operative precision. Dr. Akst received his undergraduate and medical degrees from Yale University, did his Otolaryngology residency at the Cleveland Clinic, and completed his laryngology fellowship at Massachusetts General Hospital.

Abstract:

This presentation will comprehensively review evaluation and management of laryngeal leukoplakia. Though white vocal fold lesions are common, management remains challenging; doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia through scar. I will present a framework for management of leukoplakia which balances oncologic with functional outcomes with the goal of achieving disease control without creating scar. State-of-the-art advances in care of leukoplakia will be emphasized and surgical techniques discussed will include role of infusion, use of the KTP laser and microflap resection of diseased epithelium. Advanced use of the KTP laser for office treatment of laryngeal dysplasia, an important part of my own practice and something which is only available in a limited number of centers worldwide will be discussed as well, to include appropriate anesthesia techniques for office-based procedures. Epidemiology of leukoplakia, rates of progression to malignancy and role of office-based biopsy will be reviewed. Though focus will be on KTP laser strategies as these represent cutting edge approached to management of this disease, I will also discuss cold instrument and CO2 laser techniques so that the audience, regardless of the tools available to them in their own practices, will be able to transition techniques learned in this presentation to care of their own patients. Approaches to anterior commissure involvement, bilateral disease and multiply recurrent dysplasia will be discussed through case presentations which should increase audience interest.

Biography:

1984: One of the pioneers in introducing 3D imaging in Neuroradiology.

1985: Replaced X-ray poly-tomography with CT for the evaluation of the nasal cavity and paranasal sinuses. Established the CT evaluation parameters, and described the imaging anatomy and pathology of this morphologic area.

1989: Introduced IGS in the USA using a mechanical sensor technology.

1991: First to use optical sensors in IGS and applied in FESS and Neurosurgical procedures.

1992: Advised the emergent VTI team in the application of electromagnetic sensors for IG-FESS procedures.

To date have authored/co-authored over 150 publications.

Author of 7 patents.

Author of 5 textbooks.

Serves as a reviewer for several journals.

Member of several national and international societies.

Abstract:

Endoscopic Sinus Surgery (FESS) in their procedures. Image Guided Surgery (IGS) has improved the familiarity of the surgeon with the surgical field and correlation between the regional morphology and the imaging information. Unfortunately, image guidance is not always or universally available. For these situations, it is our work to provide the FESS surgeons more dynamic use of the imaging information to guide their surgical approach in a systematic and safe manner, using landmarks they are already familiar with.

Teaching Points: The surgical approach for FESS is systematic, as it progressively follows sequential surgical steps and landmarks, based on the four lamellae from anterior to posterior, uncinate process, ethmoidal bulla, basal lamella and superior turbinate.

The aim of this communication is to highlight the CT evaluation of the structures related to each of these 4 lamellae and the important role that dynamic multiplanar reformatting can play.

Imaging evaluation will specifically focus on the structures involved in the performance of the 4 steps of the surgery, namely uncinectomy, anterior and posterior ethmoidectomy, sphenoidotomy and frontal sinusotomy.

Summary: Aim of this presentation is to show that, using orthogonally reconstructed MPR CT images can provide a more

accurate display of the structures of the nasal cavity and the paranasal sinuses in preparation for FESS.

Use of a more dynamic CT display is needed and more advantageous to demonstrate the intricate relationship and structural variations surrounding the various mucociliary outflow tracts/drainage pathways.

Curved coronal and 3D reconstructions are needed to display the usually convoluted path of the frontal recess and its outflow

tract. In general, this dynamic approach of the imaging evaluation can provide a more accurate pre-surgical planning platform, especially in instances where image guidance is unavailable for surgery.

Keynote Forum

Biography:

Eileen Raynor is an Associate Professor of the Pediatric Otolaryngology, Head and Neck Surgery & Communication Sciences at Duke University Health System, USA. She has been actively engaged in clinical research since Residency.

Abstract:

Coblation technology has been used in adult and pediatric adenotonsillectomy since it was introduced in 2001. Since then this device has been used in numerous head and neck procedures including nasal polypectomy, epistaxis management, lingual tonsillectomy, removal or debulking of lymphovascular or venous malformations, removal of suprastomal granulation tissue and laryngeal surgery. Coblation technology uses plasma generation that dissolves hydrogen bonds in tissue, resulting in volume reduction and lower thermal spread to surrounding structures than electrocautery techniques. Literature review of techniques and indications will be supplemented with specific case presentations.

Biography:

Belayat Hossain Siddiquee is a Pioneer Head Neck Surgeon in Bangladesh. He started career as Head Neck Surgeons in 1992 after obtaining Fellowship in ORLHNS from Bangladesh . He is first person posted as Professor of Head-Neck Surgery in the University Hospital of the country. He is Founder chief of HNS Division,BSMMU, Founder president, Bangladesh Society of HN Surgeons, Governing Council Member, Asian Society Head-Neck Oncology (ASHNO), Councilor, IFHNOS, Country Coordinator, World Head-Neck Cancer Day and Editorial Board Member, Springer journal “Oral Cancer”. He is working to improve skill of HN Surgeon’s of his country to global level, make facilities for HN Surgery accessible to common people.

Abstract:

Advance laryngeal carcinoma with N0 neck is a condition where controversies about surgical management are still present. Clearance of the echelon groups of cervical lymph nodes in clinically and radiologically negative neck during surgery for laryngeal primary has got a positive impact on prognosis. We have treated 114 such cases over thirteen years (2001-2013). Fifty five (55) were glottic and 59 supraglottic carcinoma. Surgery was done both in primary and irradiated cases: Primary modality in 53 cases (Glottic-23 and Supraglottic-30) and 61 irradiated cases (Glottic-32 and Supraglottic-29). Two types of surgery offered were (1) Total Laryngectomy, (2) Total Laryngectomy+Bilateral Selective Neck Dissection of Level-II, III, IV lymph nodes (Bil.SND). Total laryngectomy was done in 41 cases (Glottic-20 and Supraglottic-21), Total Laryngectomy+Bil.SND in 73 cases (Glottic-35 and Supraglottic-38). Postoperative adjuvant radiotherapy was given according to demand of the postoperative histopathology. 97.37% (111 patients) were followed up for >2 years, 74.35% (85 cases) >3 years and 45.61% (52 cases) for >5 years. Recurrence detected in 15 cases of Glottic carcinoma, Laryngectomy group-11 (55%) and Laryngectomy+Bil.SND-04 cases (11.43%; p=0.001). In supraglottic carcinoma recurrence found in 20 cases, Laryngectomy group-11 (52.38%) and Laryngectomy+Bil.SND-09 cases (23, 68%; p=0.026). Most of the recurrence (68.18%) occurs in the neck if not addressed properly during surgery. Prophylactic Bilateral SND in advance carcinoma of the larynx with N0 neck has significant influence in reducing recurrence.

Keynote Forum

Biography:

Prof. Yehuda Ullmann is Head of the Plastic Surgery Department and Aesthetic Services at Rambam Healthcare Campus in Haifa, Israel. In addition, he is a Associate Clinical Professor of Plastic Surgery at the Rappaport Faculty of Medicine of the Technion-Israel Institute of Technology. Prof. Ullmann's research interests include increasing viability of autologous fat transplants, and reconstructive and aesthetic surgery, and he has published over 120 articles in peer-reviewed journals. He is also an internationally acknowledged expert in the use of laser and IPL technologies. Until recently, Prof. Ullmann served as President of the Israel Society of Plastic Surgery.

Abstract:

Doubts are commonly cast over the safety of the single-stage augmentation mastopexy procedure. Currently, the literature is sparse. Applying the “Lejour” technique for augmentation mastopexy has provided excellent aesthetic results and significantly reduced complications. Hereby presented is this easy to learn reproducible technique, allowing one to perform both procedures together safely. To the best of our knowledge, this is the first description written in the English literature.

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